Cates M, Powers R
Samford University McWhorter School of Pharmacy, Birmingham, AL, USA.
Ann Pharmacother. 1998 Sep;32(9):884-7. doi: 10.1345/aph.17445.
Rashes and blood dyscrasias are disconcerting adverse effects associated with carbamazepine therapy. Rashes are quite common, as are mild blood dyscrasias, such as mild leukopenias. Fortunately, severe rashes and blood dyscrasias are rare. There are few reports on the relationship between carbamazepine-induced rashes and blood dyscrasias, including a prospective study in which rash appeared concomitantly with leukopenia and/or thrombocytopenia in 10 patients, two case reports in which simultaneous rash and agranulocytosis occurred, and two case reports in which rashes served as harbingers of fatal aplastic anemia.
We report two cases of concomitant rashes and blood dyscrasias in geriatric psychiatry patients receiving carbamazepine therapy for bipolar disorder. One patient was found to have a severe leukopenia within several days after rash onset. The other patient was discovered to have a severe leukopenia and thrombocytopenia within about a month after rash onset.
Current hematologic monitoring guidelines for carbamazepine rely heavily on the recognition of signs and symptoms of blood dyscrasias by clinicians and patients. We believe that our cases support the suggestion that patients who develop rashes receive more vigilant monitoring of the complete blood count, should carbamazepine therapy by continued. Given the currently available case reports and the fact that the incidence of drug-induced blood dyscrasias increases with advanced age, this recommendation may be particularly relevant for geriatric patients.
Further study is required to establish whether carbamazepine-induced concomitant rashes and blood dyscrasias are valid associations insofar as monitoring is concerned.
皮疹和血液系统异常是与卡马西平治疗相关的令人不安的不良反应。皮疹相当常见，轻度血液系统异常如轻度白细胞减少症也很常见。幸运的是，严重皮疹和血液系统异常很少见。关于卡马西平引起的皮疹与血液系统异常之间关系的报道很少，包括一项前瞻性研究，其中10例患者皮疹与白细胞减少和/或血小板减少同时出现，两篇病例报告中皮疹与粒细胞缺乏症同时发生，以及两篇病例报告中皮疹是致命再生障碍性贫血的先兆。
我们报告两例老年精神病患者在接受卡马西平治疗双相情感障碍时出现皮疹和血液系统异常同时发生的病例。一名患者在皮疹发作后数天内被发现有严重白细胞减少症。另一名患者在皮疹发作后约一个月内被发现有严重白细胞减少症和血小板减少症。
目前卡马西平的血液学监测指南很大程度上依赖临床医生和患者对血液系统异常体征和症状的识别。我们认为我们的病例支持这样的建议，即出现皮疹的患者如果继续接受卡马西平治疗，应更密切地监测全血细胞计数。鉴于目前可用的病例报告以及药物性血液系统异常的发生率随年龄增长而增加这一事实，这一建议可能对老年患者尤为重要。
就监测而言，是否卡马西平引起的皮疹和血液系统异常同时发生是有效的关联，还需要进一步研究来确定。
